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Evidence-based medicine in HBP surgery: Is there any?

Jeppsson, Bengt LU and Thorlacius, Henrik LU (2005) In HPB 7(3). p.197-200
Abstract
Background. Evidence-based medicine (EBM) has become widely accepted as a basis for clinical decision in many fields of medicine. This review examines the specific role of EBM in hepato-biliary and pancreatic (HBP) surgery. EBM relies on four main sources, including clinical guidelines, meta-analyses, primary information and clinical experience. Randomized controlled trials (RCTs) constitute the cornerstone of EBM and a recent study reported that there are relatively few RCTs evaluating the effectiveness of surgical therapies and procedures (1,530 out of 45,342 or 3.4% in five leading surgical journals) and only a few in HBP surgery. Although the effort must be to implement EBM as far as possible in HBP surgery, there are several obstacles... (More)
Background. Evidence-based medicine (EBM) has become widely accepted as a basis for clinical decision in many fields of medicine. This review examines the specific role of EBM in hepato-biliary and pancreatic (HBP) surgery. EBM relies on four main sources, including clinical guidelines, meta-analyses, primary information and clinical experience. Randomized controlled trials (RCTs) constitute the cornerstone of EBM and a recent study reported that there are relatively few RCTs evaluating the effectiveness of surgical therapies and procedures (1,530 out of 45,342 or 3.4% in five leading surgical journals) and only a few in HBP surgery. Although the effort must be to implement EBM as far as possible in HBP surgery, there are several obstacles to conducting RCTs in HBP surgery, including problems associated with standardization of surgical skills, sham-operations often impossible to perform, and the general applicability of specific findings may be uncertain.Discussion. This paper will provide two relevant examples of EBM in HBP surgery in patients with hepatic metastases and pancreatic adenocarcinoma, illustrating some problems but also the potential of introducing EBM in HBP surgery. In the future, our effort must be devoted to implementing EBM in applicable areas of HBP surgery but also remembering that in certain areas accumulated knowledge from observational studies, including drainage of abscesses and surgical treatment of intestinal obstruction, may have similar or even higher clinical value than RCTs. (Less)
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author
organization
publishing date
type
Contribution to journal
publication status
published
subject
keywords
hepato-biliary surgery, liver metastases, Evidence-based medicine, pancreatic resection
in
HPB
volume
7
issue
3
pages
197 - 200
publisher
Informa Healthcare
external identifiers
  • pmid:18333189
  • scopus:27544476375
ISSN
1477-2574
DOI
10.1080/13651820510028783
language
English
LU publication?
yes
id
6e5773a6-ff45-4141-8d56-7fc191ca9979 (old id 1052602)
alternative location
http://www.ncbi.nlm.nih.gov/pubmed/18333189?dopt=Abstract
date added to LUP
2008-04-01 16:05:04
date last changed
2017-01-01 04:49:07
@article{6e5773a6-ff45-4141-8d56-7fc191ca9979,
  abstract     = {Background. Evidence-based medicine (EBM) has become widely accepted as a basis for clinical decision in many fields of medicine. This review examines the specific role of EBM in hepato-biliary and pancreatic (HBP) surgery. EBM relies on four main sources, including clinical guidelines, meta-analyses, primary information and clinical experience. Randomized controlled trials (RCTs) constitute the cornerstone of EBM and a recent study reported that there are relatively few RCTs evaluating the effectiveness of surgical therapies and procedures (1,530 out of 45,342 or 3.4% in five leading surgical journals) and only a few in HBP surgery. Although the effort must be to implement EBM as far as possible in HBP surgery, there are several obstacles to conducting RCTs in HBP surgery, including problems associated with standardization of surgical skills, sham-operations often impossible to perform, and the general applicability of specific findings may be uncertain.Discussion. This paper will provide two relevant examples of EBM in HBP surgery in patients with hepatic metastases and pancreatic adenocarcinoma, illustrating some problems but also the potential of introducing EBM in HBP surgery. In the future, our effort must be devoted to implementing EBM in applicable areas of HBP surgery but also remembering that in certain areas accumulated knowledge from observational studies, including drainage of abscesses and surgical treatment of intestinal obstruction, may have similar or even higher clinical value than RCTs.},
  author       = {Jeppsson, Bengt and Thorlacius, Henrik},
  issn         = {1477-2574},
  keyword      = {hepato-biliary surgery,liver metastases,Evidence-based medicine,pancreatic resection},
  language     = {eng},
  number       = {3},
  pages        = {197--200},
  publisher    = {Informa Healthcare},
  series       = {HPB},
  title        = {Evidence-based medicine in HBP surgery: Is there any?},
  url          = {http://dx.doi.org/10.1080/13651820510028783},
  volume       = {7},
  year         = {2005},
}